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National COVID-19 taskforce cautions against hydroxychloroquine use


Anastasia Tsirtsakis


25/05/2020 3:02:24 PM

The latest guidance for the care of coronavirus patients.

Chloroquine manufacturing
Taskforce Chair Associate Professor Julian Elliott said speculation about the preventive use of hydroxychloroquine and chloroquine has the potential to downplay the severity of risks. (Image: AAP)

The National COVID-19 Clinical Evidence Taskforce (the taskforce) has cautioned against the use of hydroxychloroquine for the prevention and treatment of COVID-19 outside of a clinical trial.
 
Taskforce Chair Associate Professor Julian Elliott noted that speculation about the preventive use of the anti-malaria drug has the potential to downplay the severity of risks.
 
‘Speculation about using unproven treatments like hydroxychloroquine to prevent COVID-19 is confusing for people because they mainly hear the positive commentary despite the fact there is no evidence of benefit and the known risks are substantial,’ he said.
 
‘As a national body that is monitoring the evidence daily, our guidelines are crystal clear that there is no evidence to suggest anyone should take hydroxychloroquine either for the prevention or treatment of COVID-19 unless they are part of a randomised clinical trial.’
 
Hydroxychloroquine and chloroquine have risen to prominence during the COVID-19 pandemic.
 
Australian businessman and former federal MP Clive Palmer, who bought and donated nearly 33 million doses of hydroxychloroquine, took out a full page newspaper advertisement in April, stating the drug was Australia’s ‘best hope’ for treating patients with COVID-19.
 
US President Donald Trump this month confirmed that he had been taking the drug to ‘ward off’ COVID-19, despite warnings by public health officials.
 
Meanwhile, an Australian clinical trial has started recruiting frontline healthcare workers deemed to be at high risk of contracting coronavirus, to determine whether hydroxychloroquine can be taken as a preventive measure.
 
RACGP President Dr Harry Nespolon said while news of the trial is positive, he cautioned against taking the drugs.
 
‘There is quite simply insufficient evidence that hydroxychloroquine and chloroquine can “cure” COVID-19. So the drugs should not be provided to patients outside of a formal randomised clinical trial and I also strongly advise against acquiring these drugs on the dark web or anywhere else,’ he said.
 
‘We need to exercise extreme caution here.
 
‘Some studies have also indicated an elevated risk of serious adverse effects like cardiac arrest.’
 
Dr Nespolon highlighted that sourcing the drug may also have unintended consequences for other patients who regularly use it for existing medical conditions.
 
‘Let me be 100% clear: we need to ensure there is stock available for those who actually need this drug right now,’ he said.
 
‘Off-label use of hydroxychloroquine can have significant consequences for those who are normally prescribed the drug and really need it.’
 
When it comes to the use of other antiviral drugs and disease-modifying treatments, the taskforce continues to recommend they only be used ‘in the context of randomised trials with appropriate ethical approval’.
 
For adults with COVID-19 undergoing endotracheal intubation, current guidance regarding video laryngoscopy – if the technology is available and the operator is trained in its use – has been further reinforced with evidence.
 
GPs can also access an updated clinical flowchart for the assessment of suspected COVID-19.
 
The taskforce has established a new expert advisory group and is in the process of convening a palliative and aged care panel to offer specialised clinical recommendations for these at-risk patient cohorts.
 
The taskforce is also expanding its scope to include chemoprophylaxis for COVID-19 based on significant interest from healthcare workers and the general public.
 
With a vast number of studies testing various drugs to lower the rate of infection, living clinical recommendations as results become available will ensure clinicians have the latest evidence-based advice.
 
Other clinical questions currently under review include: 

  • use of continuous positive airway pressure (CPAP)
  • protocols for managing stroke and cardiac arrest
  • use of neuromuscular blocking agent
  • use of corticosteroids
  • timing of mechanical ventilation
  • high-dose VTE prophylaxis
  • tracheostomy (timing and procedure).
The national clinical guidelines for COVID-19 will continue to be updated weekly throughout the pandemic.
 
GPs are encouraged to submit their clinical questions and provide feedback on the taskforce website.
 
The RACGP has more information on coronavirus available on its website.
 
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